Recent USPSTF recommendations will go far to identify patients with type 2 diabetes and prediabetes, but maybe not far enough.
New US Preventive Services Task Force recommendations to screen for abnormal blood glucose levels in overweight and obese patients aged 40 to 70 years will identify many patients with type 2 diabetes mellitus (DM) and prediabetes.
But, according to the American Diabetes Association (ADA), the screening guidelines do not go far enough.
The Task Force published a final recommendation statement on screening to prevent type 2 DM on October 27, 2015. The guideline suggests clinicians offer or refer patients with abnormal blood glucose levels to intensive behavioral counseling interventions to promote healthful diet and physical activity.
The previous Task Force recommendation statement in 2008 recommended screening for DM in asymptomatic adults with hypertension. New evidence, including 6 lifestyle intervention studies, led the Task Force to conclude, “There is moderate net benefit to measuring blood glucose in adults who are at increased risk for diabetes.”
However, the final guidelines fall short of the Task Force’s draft recommendation, released in October of 2014, according to a statement from the ADA. The Task Force acknowledged the importance of screening patients with risk factors in its draft recommendation but backtracked substantially in the final recommendation.
Robert Ratner, MD, the ADA’s Chief Scientific & Medical Officer, said, “It is shocking that the USPSTF ignored the morbidity and mortality associated with diabetes itself and chose to view diabetes screening solely through a focus on cardiovascular disease risk.”
The ADA thinks the new recommendations ignore younger adults aged 20 to 44 years, in whom the rate of undiagnosed DM is 60% higher than in the adult population as a whole. The final screening recommendation also does not recognize populations, such as minorities, who are at increased risk for type 2 DM. The Task Force acknowledges in its Clinical Considerations that these populations might need earlier screening.
“In addition to the at-risk, minority populations that are not addressed in the new guidelines, the age bracket covered for screening does not encompass all who are at risk,” Dr Ratner said. “Diabetes screening should not be limited to ages 40-70. This grossly ignores the evidence of the National Institutes of Health’s Diabetes Prevention Program (DPP) that found individuals at high risk as young as age 25 are able to reduce their risk for type 2 diabetes. Moreover, there was no upper age limit in the DPP trial, and seniors had an even higher success rate with lifestyle intervention.”
Dr Ratner also noted that women with a history of gestational DM are at highest risk for type 2 DM-type 2 DM develops in half of them within 5 years. “Beginning screening at age 40 is too little too late for many of these women with a history of gestational diabetes. They may have had diabetes for 5 to 10 years by then," he said.
The Task Force notes that the ADA recommends screening for DM in adults aged 45 years or older and screening in persons who have multiple risk factors regardless of age and that multiple other medical associations recommend screening for DM in persons who have risk factors only.